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CLINICAL PHARMACOLOGY 2003 (PART 13)

Infection is a major category of human disease and skilled management of antimicrobial drugs is of the first importance.The term chemotherapy is used for the drug treatment of parasitic infections in which the parasites (viruses, bacteria, protozoa, fungi, worms) are destroyed or removed without injuring the hostThe use of the term to cover all drug or synthetic drug therapy needlessly removes a distinction which is convenient to the clinician and has the sanction of long usage. | SECTION 3 INFECTION AND INFLAMMATION This page intentionally left blank SECTION 3 Chemotherapy of infections SYNOPSIS Infection is a major category of human disease and skilled management of antimicrobial drugs is of the first importance.The term chemotherapy is used for the drug treatment of parasitic infections in which the parasites viruses bacteria protozoa fungi worms are destroyed or removed without injuring the host.The use of the term to cover all drug or synthetic drug therapy needlessly removes a distinction which is convenient to the clinician and has the sanction of long usage. By convention the term is also used to include therapy of cancer. Classification of antimicrobial drugs How antimicrobials act Principles of optimal antimicrobial therapy Use of antimicrobial drugs choice combinations chemoprophylaxis and preemptive suppressive therapy Problems with antimicrobial drugs resistance opportunistic infection masking of infections Antimicrobial drugs of choice Reference table HISTORY Many substances that we now know to possess therapeutic efficacy were first used in the distant past. The Ancient Greeks used male fem and the Aztecs chenopodium as intestinal anthelminthics. The Ancient Hindus treated leprosy with chaul-moogra. For hundreds of years moulds have been applied to wounds but despite the introduction of mercury as a treatment for syphilis 16th century and the use of cinchona bark against malaria 17th century the history of modern rational chemotherapy did not begin until Ehrlich1 developed the idea from his observation that aniline dyes selectively stained bacteria in tissue microscopic preparations and could selectively kill them. He invented the word chemotherapy and in 1906 he wrote In order to use chemotherapy successfully we must search for substances which have an affinity for the cells of the parasites and a power of killing them greater than the damage such substances cause to the organism itself . This means . we must learn to aim .